There is mounting evidence and concern that our health care system is inadequately prepared to respond to increasing public attention to potential adverse health effects from exposure to a wide range of environmental factors. Deficiencies in medical education at the undergraduate, graduate and post-graduate levels are a major contributor to the underinvolvement of primary care physicians in environmental /occupational medicine (EOM). There is presently no comprehensive and coordinated EOM curriculum at the University of Washington and the design, development and evaluation of a curriculum focused on EOM is proposed. These efforts will be based in the Occupational Medicine Program in the Department of Medicine, which has a history of effective multidisciplinary collaboration in clinical care, teaching and research. In order to achieve the overall objective of enhancing existing and implementing new curricula in EOM, specific aims have been developed in three areas: undergraduate medical education, graduate and continuing medical education for non-specialist physicians, and specialty training in EOM. In collaboration with faculty in the Schools of Nursing and Public Health and Community Medicine, EOM concepts will be introduced initially into the School of Medicine's four primary care specialty clerkships (internal medicine, family medicine, pediatrics and obstetrics and gynecology) and selected graduate training programs (internal medicine, family medicine, pediatrics, obstetrics and gynecology, neurology, pulmonary and critical care, and preventive medicine). Continuing education's proposed for physicians and other health professionals in the WAMI (Washington, Alaska, Montana and Idaho) region, including rural practice settings. Innovative teaching techniques are to be developed and tested, including computerized patient management problems (CPMPs) and Objective Structured Clinical Evaluations (OSCEs). Finally, the expertise of the PI and key faculty will be broadened to enable the successful incorporation of non-occupational aspects of environmental medicine into the clinical, research and teaching activities of the Occupational Medicine Program.